Boletín médico del Hospital Infantil de México最新文献

Background: Eating disorders are a group of diseases with psychiatric background associated with physical manifestations related to weight and body image. We can classify patients with diabetes, into those who suffer from eating disorders or disordered eating behaviors, both being associated with the typical symptoms of eating behavior disorders. The objective was to analyze the frequency and factors associated with nutrition disorders in adolescents with type 1 diabetes.

Method: Observational, cross-sectional, prospective and descriptive study of 100 adolescents with type 1 diabetes to whom the DEPS-R survey was applied to determine the frequency of nutrition disorders.

Results: A positive DEPS-R survey score was presented for appearance of eating disorders in patients with type 1 diabetes in 33% of patients cases. There was a positive association using the χ² test between body mass index and a positive screening (p = 0.006) and with uncontrolled glycated hemoglobin (p < 0.05), without being related to the patients sex (p = 0.20).

Conclusions: The DEPS-R survey is applicable to the Mexican population to screen for risk of altered eating behaviors at pediatric age. Patients with poor glycemic control, overweight and obesity have higher prevalence of eating disorders.

Background: Melanomas represent a small percentage of skin malignancies, but they represent the majority of deaths from skin cancer. The etiology of vulvar melanomas may differ from other melanomas, where the most important risk factor is exposure to ultraviolet light. Compared to adults, pediatric melanomas have an atypical clinical presentation, posing as low-suspicion lesions, thus leading to a diagnostic delay and increased mortality in this patient population.

Clinical case: A 10-year-old female with a painful hyperpigmented lesion localized in the left vulvar region, with no other associated symptoms. Dermatology assessment described a palpable neoformation of 5 × 6 mm, black color, with irregular borders. Dermoscopy shown asymmetrical pattern, peripheral globules, irregular projections, and blue-white veil. Subsequently, an excisional biopsy of the lesion was performed, with a histopathological report of melanoma HMB45 positive, p-53 positive and focal Ki-67, negative margins. Further studies revealed no evidence of metastatic activity; therefore, it was decided to continue medical surveillance by the pediatric oncology service.

Conclusions: Vulvar melanoma is a malignant entity with a low incidence rate. There are no case reports published in Mexico that describe its location in the pediatric population. Given the high mortality, early diagnosis and treatment would improve life expectancy in our patients.

Background: Schizencephaly is a congenital alteration of the architecture of the cerebral cortex, and its diagnosis in the neonatal period will be determined by prenatal diagnosis or severity of the cases.

Clinical cases: We present three neonatal cases with variable clinical expression and electroencephalographic findings during clinical course. Case 1: term neonate, born by cesarean section due to pre-eclampsia and presenting early respiratory distress. On clinical examination, macrocranial was clear, so a cranial tomography (CT) scan was performed showing bilateral open-lip schizencephaly. He early presented recurrent seizure, associated with hypotonia, and swallowing disorder with little improvement despite interventions, and palliative management was decided. Case 2: 36-week-old neonate with a prenatal diagnosis of schizencephaly and delivery by cesarean section due to altered fetal monitoring. Low birth weight and requiring positive pressure ventilation. On day 2, CT scan confirmed the prenatal diagnosis and the video electroencephalogram was normal. Progression of enteral feeding was achieved, without neurological deterioration, and the patient was discharged with recommendations for follow-up. An outpatient magnetic resonance imaging confirms the diagnosis. Case 3: preterm twin of 34 weeks, with prenatal diagnosis of ventriculomegaly. At birth without achieving early saturation goals and on clinical examination with large macrocrania and CT scan showing an image suggestive of open-lipped schizencephaly, associated with hydrocephalus, dysgenesis/agenesis of the corpus callosum. Seizure of difficult control, and required ventriculoperitoneal shunt.

Conclusions: Neonatal clinical course is variable but seizures are relevant. Other assessments may be needed early, including genetic concepts.

Background: We present the case of a newborn with respiratory aspiration of barium and the management of this complication by serial bronchoalveolar lavage through bronchoscopy.

Clinical case: Female newborn, who underwent barium esophagogram for suspected esophageal atresia, who presented subsequent torpid evolution and radiological changes with persistent radiopaque image, metal density in the left apical and right basal region. Three bronchoalveolar lavages were performed with a decrease in the radiopacity generated by the contrast medium and clinical improvement.

Conclusions: Barium aspiration is a possible complication of digestive tract imaging studies and there is no specific management. In our patient, we found a possible benefit from performing serial bronchoalveolar lavages.

Background: The Child Care Facilities Program (PEI, for its Spanish acronym) in Mexico targets parents of children aged 1-3 years living in poverty, providing education and care strategies 5 days a week. This study aimed to evaluate the impact of a 6-month stay in childcare centers on the developmental levels of children under 4 years old.

Methods: A longitudinal, before-and-after study was conducted. Children aged 12-42 months enrolled in the PEI were included in the study. All participants remained in the program for 6 months from the first measurement. The overall and area-specific developmental levels were assessed using the Early Childhood Development Assessment (EDI, for its Spanish acronym) test. The percentages of developmental levels (normal, delayed, and at risk of delay) were compared between the baseline and 6-month assessments using the McNemar test.

Results: The study included 1835 children, of whom 52% were male. The age distribution was as follows: 28.1% were 12-24 months old, 48.4% were 25-36 months old, and 23.5% were 37-42 months old. At baseline, 80.5% (n = 1,476) of the children were classified as having normal overall development, 16% had developmental delay, and 3.5% were at risk for delay. After 6 months, the percentage of children with normal development increased to 90.1%, while those with developmental delay and those at risk for delay decreased to 8.7% and 1.2%, respectively. Similar improvements were observed across various developmental areas, except in the knowledge area.

Conclusions: A 6-month stay in childcare centers is beneficial for improving the developmental levels of children under 4 years old, both overall and in motor, language, social, and cognitive areas.

Background: Prematurity is associated with a higher risk of disability. However, no studies on this population in rehabilitation settings in Peru have been found. This study aims to describe the characteristics of preterm infants at the Pediatric Rehabilitation Service of Hospital Nacional Edgardo Rebagliati Martins (SRP-HNERM).

Method: A cross-sectional descriptive study was conducted. Medical records of preterm infants at SRP-HNERM from September 2023 to February 2024 were reviewed. The Hammersmith Infant Neurological Examination (HINE), General Movements Assessment (GMA), and other outcome measures were used for evaluation.

Results: A total of 158 preterm infants were evaluated. During hospitalization, 51.3% were evaluated by a physiatrist, 47.5% received physical therapy, and 51.3% had feeding and swallowing disorders (FSD). After discharge, all patients were evaluated by a physiatrist at SRP-HNERM. Among infants with ≥ 44 weeks of corrected gestational age (CGA), 48.1% showed some degree of developmental delay, with global delay present in 34%. Of those with ≥ 48 weeks of CGA, 54.9% had an optimal HINE score. Normal GMA was observed in 51.2% of infants with ≤ 5 months of CGA. A higher frequency of global developmental delay was found in infants who had FSD during hospitalization and a lower frequency in those who had neonatal jaundice.

Conclusions: Slightly more than half of the preterm infants were evaluated by a physiatrist, had FSD during hospitalization, had an optimal HINE score at ≥ 48 weeks of CGA, and had a normal GMA at ≤ 5 months of CGA. The presence of FSD during hospitalization should alert clinicians to a higher risk of global developmental delay in this population.

Background: Hydrocele of the canal of Nuck is a rare pathology with a prevalence of approximately 1% in females aged 0-16 years. Its prevalence in adults remains unknown. The condition develops due to persistent patency or failed obliteration of the canal of Nuck. Several factors may contribute to its development, including lymphatic disorders, trauma, infection, inflammation, or idiopathic causes. Clinically, it presents as edema in the groin or genital region without additional symptoms. Ultrasonography is the preferred diagnostic modality for hydrocele of the canal of Nuck.

Case report: We present the case of a 20-month-old female patient who presented with pain and a "lump" in the right inguinal region for 3 days. The patient was diagnosed with type 1 hydrocele of the canal of Nuck through ultrasonography, which was subsequently confirmed during surgery. The patient was discharged on the same day as the procedure and remains asymptomatic.

Conclusions: Although rare, hydrocele of the canal of Nuck should be considered in the differential diagnosis of groin or genital region edema presenting without additional symptoms. Its diagnosis can be challenging due to several common differential diagnoses, including indirect inguinal hernia, tumors, cysts, abscesses, and lymphadenopathies, which occur more frequently. Therefore, ultrasonography plays a crucial role in evaluating these differential diagnoses and confirming the hydrocele of the canal of Nuck.

Background: Waiting times for elective surgery can be a physically and psychologically distressing experience for patients, affecting their satisfaction and perceptions of service quality. This study aimed to estimate the waiting time for pediatric patients admitted for elective surgery, identify events causing delays, and compare variations in the admission process.

Method: Three cohorts of pediatric patients scheduled for elective surgery were prospectively followed: (A) weekday general surgery admissions, (B) weekday admissions to other surgical specialties, and (C) weekend surgical admissions. The admission process was mapped, timescales of each stage were recorded, and delay incidents were identified through direct non-participant observation after obtaining informed consent or assent.

Results: The mean waiting time was 6.9 h (95% confidence interval [CI]: 6.6-7.2 h) for all scheduled surgical admissions. Patients in cohort B experienced the longest waiting time at 8.1 h (95% CI: 7.7-8.5 h, p < 0.0001). Primary causes of delay included lengthy transfers to the admission area, bed management issues, and limited staff availability during shift changes. Avoidable delays resulted in a mean additional waiting time of 1.4 h.

Conclusions: The findings suggest that hospital waiting times could be reduced through organizational interventions targeting the main causes of delay and simplifying administrative processes.

Developmental pediatrics (DP) in Mexico has taken a crucial step forward in the creation of the Developmental and Behavioral Pediatrics Service (SPDC, for its acronym in Spanish) at Hospital Infantil de México Federico Gómez (HIMFG). The SPDC is a leading area in early detection and intervention in neurodevelopmental problems and contributes to children's well-being. Among its achievements are the development and implementation of the Child Development Evaluation Test, which has been validated for children under 6 years old, and of a free virtual training program for medical personnel that is supported by an interactive platform. Furthermore, the SPDC is the only center in Mexico to offer a postgraduate degree in DP. With a fair and evidence-based approach, the SPDC contributes to the strengthening of public policy, research, and comprehensive care to ensure children's development.

Background: Play is a fundamental component of children's social, emotional, cognitive, and physical development. This study focused on assesses a play-based intervention method to promote overall child development based on parental involvement, delivered at primary care facilities.

Methods: Quasi-experimental study was conducted with children 24-59 months old, regularly attending the monthly stimulation sessions in primary care facilities in the state of Puebla, Mexico, from November 2015 to April 2016. Play interventions were administered over six sessions each month 1-h length individually for the dyad, included free play time, and each session one activity at home that include the five areas of development and with some materials provided but encouraged to use more available at home. The Child Development Evaluation (EDI) test was administered at baseline, 3 and 6 months after the intervention. A comprehensive data set encompassing demographic variables was collected and analyzed. McNemar test was used to assess developmental changes over time.

Results: The sample consisted of 276 children, 60.5% were male, median age 40 months (interquartile range: 34-46). All participants attend the six sessions and conducted activities daily at home. Overall, the percentage of children with abnormal result with EDI test was 77.2% at baseline and 17.4% final measurement at 6 months (p < 0.001), with mild-delay decreased from 39.9% to 6.9% and high-risk of delay from 37.3% to 10.5%.

Conclusion: The play intervention resulted in a clinically and statistically significant improvement in the developmental outcomes of the children, both with normal/abnormal result at baseline.